NPIMap

Individual provider Active NPI

Amimi Sandra Osayande, M.D.

  • Family Medicine Physician
  • Lawrenceville, GA
National Provider Identifier
1821288077
Registry record updated Mar 16, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
075161 Issued in GA
Practice address
665 Duluth Hwy
Suite 501
Lawrenceville, GA 30046-3328
Phone
(678) 312-0400
Fax
(678) 312-0423
NPI assigned
Jul 25, 2007
Last updated
Mar 16, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2008-01550 NC
Family Medicine Physician 207Q00000X 075161 GA Primary

Addresses

Primary practice location

665 Duluth Hwy
Suite 501
Lawrenceville, GA 30046-3328

Mailing address

PO Box 116360
Atlanta, GA 30368-6360
Phone (214) 648-1399

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, GA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100107000078 TX Practitioner - Family Practice 0446327530 Reassigns benefits to 1 organization
I20160627001688 GA Practitioner - Family Practice 0446327530 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gwinnett Hospital System Gme, LLCGroup PAC ID 0648504894, 23 clinicians

Practice addresses (Care Compare)

1000 Medical Ctr Blvd
Lawrenceville, GA 30046-7694
Phone (678) 312-5527

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2008-01550NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gwinnett Pathology Assoc PC Current Accepting new patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Jan 1, 2010 Accepting new patients
Gwinnett Physician Group, LLC Family Medicine CurrentSince Jun 1, 2016 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Family Medicine CurrentSince Jan 1, 2010 Accepting new patients
Gwinnett Hospital System Gme, LLC Family Medicine CurrentSince Jul 1, 2019 Accepting new patients
Gwinnett Medical Group, Inc Family Medicine Current Accepting new patients
Northside Hospital, Inc. CurrentSince Jun 1, 2016 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Current Accepting new patients
Northside Hospital, Inc. Current Accepting new patients

Locations

1000 Medical Center Blvd
Lawrenceville, GA 30046
Phone (678) 312-3356

665 Duluth Hwy
Ste 501
Lawrenceville, GA 30046
Phone (678) 312-0400

1000 Johnson Ferry Rd
Sandy Springs, GA 30342
Phone (404) 851-8737

3000 N Interstate 35
Denton, TX 76201
Phone (469) 303-3591

5323 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489622400000",
    "number": "1821288077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 116360",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303686360",
            "telephone_number": "214-648-1399",
            "fax_number": "214-648-1307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "665 DULUTH HWY",
            "address_2": "SUITE 501",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300463328",
            "telephone_number": "678-312-0400",
            "fax_number": "678-312-0423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OSAYANDE",
        "first_name": "AMIMI",
        "middle_name": "SANDRA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-25",
        "last_updated": "2017-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2008-01550",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "075161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

Verify at the official NPI Registry.